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HealinG
KNEE INJURIES WITHOUT SURGERY
Ross
Hauser, M.D.
Prolotherapy, in my opinion, is the best way to avoid surgery! It can promote the repair of torn
cruciate ligaments,
torn medial collateral ligaments, injured
meniscus and
chondromalacia.
There are some general principles about
healing knee injuries without surgery. One of the first principles is to keep the area moving, while at the same time protecting the joint from strong stresses.
immobilization of the injured joint causes the repaired area to become weaker and thinner and often leads to a stiff joint. This is due to a combination of adhesions in the joint and/or shortening of ligaments, and weakening the site where ligaments and tendons insert to bone. This is why the R.I.C.E. (Rest, Ice, Compression, and Elevation) treatment protocols for soft tissue injuries are so detrimental to healing.
Ligaments are especially sensitive to immobility, therefore it is not recommended for any type of ligament tear or sprain when the joint itself is stable.
Interestingly, it has been shown that the more we exercise a specific joint, the stronger the bone-ligament and bone-tendon complexes become! Exercise specifically helps strengthen the
fibro-osseous
junction, which is where the ligament/tendon and bone attach to each other. Controlled activity is therefore an important part of preventing injury and healing from injury!
The standard of care for ACL tears today is surgery.
ACL reconstruction surgery involves surgically placing a prosthesis or a tendon in the place of the injured ligament. The question to ask is, "Will this surgery allow me to play again?" To answer this question athletes were followed for an average of nine years at the Sports Medicine Facility of Health Sciences at Linkoping University, in Sweden, by Dr. W. Maletius and associates. ACL replacement was performed with Dacron prostheses. In the nine year period, 65 percent of the patients required another
arthroscopy. Forty percent had
meniscal problems that were treated
arthroscopically. At the nine year follow-up only 48 percent of the patients had intact
menisci. Forty-four percent of the prostheses had ruptured during the follow-up period. Eighty-three percent of the patients had significant arthritic changes on x-ray in the operated knee. The authors concluded, "Based on the functional results of the patients with a ligament in place after nine years, only 14 percent of the original group had acceptable stability and knee function.
Surgical technique has improved and perhaps the gold standard for ACL reconstruction today is to use the
patellar tendon to replace the injured
ACL. The surgeon takes some of the patellar tendon and screws it into the femur and tibia bones to simulate an
anterior cruciate ligament. The long-term results are better than Dacron prosthesis, but are still not that great. In one five year study of arthroscopic anterior cruciate ligament reconstruction with patellar tendon graft showed that 5 percent of the patients ruptured their grafts. Of the remaining patients, about 50 percent had symptoms in their knees. Of significance to athletes was that 53 percent of them could perform at the same or a better level at five years post surgery. This means that 47 percent were performing at a lower level of activity. In another study following the patients for seven years, a slightly longer period of time, only 46 percent of the athletes could perform at the same level as their preinjury status. In this study 26 percent needed another operative procedure after the ACL reconstruction.
Substituting the real ACL for an artificial one will never be ideal. The tendon grafts have been found to be three to four times stiffer than normal ACL's and artificial graft particles have been shown to cause proliferative arthritis when injected into knees. The patient's best option is always to first try stimulating the ACL to repair itself. Case reports of complete tears healing without any treatment have been reported in the literature.
Prolotherapy can be done exactly where the ACL attaches onto the tibia and femur, in cases of a partial, thereby stimulating the ligament on both ends to proliferate and strengthen.
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